One goal of this health care information system is to empower the individual to be responsible for his own health care or for the health care information of those for whom he is the primary caregiver by providing access to important health-related information. An individual is the primary health care manager for himself and, in some cases, for his dependents. No one has more vested interests in having access to complete and accurate personal health records than the individual. The present system gains importance as we attempt to care for children, elderly parents, relatives or friends and other groups of people, especially those with chronic health problems. Also, the system is useful even to those with relatively few current health issues, in part, bedause it ensures that needed health information will be available to support future concerns that will certainly develop.
Presently, almost no one has a complete record of their personal health information. Most health care providers maintain only the information related to their services for a limited period of time and then such records are destroyed. There are some software programs available which allow the individual to manually compile information related to the health services that he or she has received. These programs also allow other information to be entered which the individual may want to track. These systems are targeted directly at benefiting the individual but are very labor-intensive.
In accordance with the present invention, a system is provided that targets the individual and provides at least summary information from health care providers automatically. Although many health care providers do not maintain electronic records, the summary information necessary to request payment from third-party payers, such as insurance companies, are all currently done electronically in a standardized format as specified by the HIPPA ASC X12 Implementation Guide. Health insurance companies and other third-party payers maintain all of their records in an electronic form, typically, and thus represent a very convenient place to obtain the summary of all services for which any health provider requests payment, and the actual amounts paid by insurance and due from the individual. This information is compiled by the present system for the individual and for those under his or her care.
The information transmitted to the third-party payer is combined and integrated with the information provided by the patient and the health care provider. Thus, the present system provides a very powerful tool for managing health care for an individual and his or her dependants. Using this system, insurance companies transmit the health information which they received for an individual to a secure web sites given proper authorization. It requires minimal effort for an insurance company to forward the information because the insurance company sends and receives the information in a standardized electronic format.
In addition, the insurance company may send explanations of benefits, preferably electronically, which confirms the information provided by the requests-for-payment. The system optionally may make use of the explanation of benefits as a double check on the information obtained from the requests-for-payment. The present system augments and is in concert with the intent of HIPPA which clearly states that an individual's medical records belong to the individual. Electronic versions of these health records are forthcoming and will create greater efficiencies in the present system and in the health care system as a whole. The information sent to health insurance companies (or other third-party payers) along with the data that an individual collects for himself allows an individual to make better health care decisions for himself, his loved ones and others. We recognize the importance of obtaining and managing our own financial records which only affect our net worth. We incorrectly assume that others are responsible for managing our health information which may eventually affect the quality or duration of our lives.
In one embodiment, the present invention is a distributed system that places the individual in control of his health care information using software on a local computer and using secure transmissions to a website. Such transmissions may be a direct Internet connection to the website or transmissions may occur with the system through e-mail or other types of communication. Using Internet connections, e-mail, faxes, and regular mail, the system automatically obtains information from insurance companies (third-party payers) initially, and using the insurance company information seeks information from actual providers. The arrival of data from the insurance company serves to automatically, at the user's option, generate a request for specific data from the provider. The request may be sent to the provider through an Internet connection or by e-mail, mail or fax transmission. The provider is requested to give the individual part or all of the records associated with the identified services. The faxes or e-mail from the provider may be sent to locations serviced by the website or to the individual. Preferably, the faxes, e-mail or even letters are scanned, as needed, and stored electronically. This system improves efficiency and reduces expense or obtaining records especially where the records are not in digital format.
In accordance with another aspect of the system, it interviews the individual prior to visiting the office of a provider and summarizes important observations and may generate a written report. The report may include a written request for health care information that may be signed and provided to the provider at the time of service. Such request may also request that the requests-for-payment be directed to a specified patient defined place, which may be an email address of the current invention. The computer at the patient defined place will process the requests-for-payment to extract information from the document in the manner described herein and will then forward the requests-for-payment to the appropriate party for payment.
The secure website may also serve as a backup storage location for the complete health history of the individual and may serve as a source of emergency medical information if the individual so elects. The software which creates and maintains the health data repository on the personal computer will index all information so that information is presented or searched logically, preferably chronologically. Synchronization with data transmitted to the secure website is done on a periodic interval and a backup copy of the synchronized health care data repositories can be uploaded to the secure site on a prescribed interval. The individual's personal computer typically includes software that handles security issues to prevent unauthorized access and provides both standard reports and customized searches to locate information. Data for any individual in the data repository may be extracted and/or removed as the individual elects to relocate his health information, such as when a child becomes an adult and chooses to move his information. The system allows any type of data file to be inserted into the repository but unrecognized formats may require additional software to provide presentation and other utilization of that information. An interesting aspect of the system is the ability to retain files that are authenticated as unaltered from an original source and would have legal validity, such as a birth certificate, a living will, or health care power of attorney.
In this system, there may be a need to follow a special procedure during an initial period where all past records of interest are gathered by the system and records from future visits are collected incrementally. This may be important to expedite the process and reduce the costs. Providers typically use an outside service to handle generic requests for records and it may take up to three weeks to obtain the records and the individual is charged a substantial fee for such copies.
In summary, the system provides numerous tools that may be utilized by an individual to conveniently organize and understand health care information. Functions performed by the system include:
1. Stores copies of important records such as shot records, birth certificates, living wills, wills, organ donor authorization, and current pictures.
2. Generates standard health forms for schools, camps, athletic teams, insurance applications, physicians' offices, etc. . . . .
3. Stores permission forms to grant temporary health decision authorization for a child.
4. Stores emergency medical information.
5. Generates a list of current medications with prescription numbers and dates of validity.
6. Tabular and graphical trends in any variable that the user has elected to chart; for example, height, weight, blood pressure, cholesterol levels, etc.
7. Generates chronological lists or cumulative tallies of important events, such as seizures, breathing distress, a diabetic reaction, high fevers, ear infections, etc.
8. Lists all tests or a specific test that has been performed and where the test results are located.
9. Stores observations, data and events that might be associated with illness or injury that the patient is logging prior to visiting a physician; for example, activities, foods, contacts, temperatures, vomiting, diarrhea, other symptoms, and notebook or diary for recording circumstances.
10. Lists dental services.
11. Lists physician visits or therapy services.
12. Stores an eye examination and specifications of corrective lenses.
13. Stores health expenses records for each individual, family or group.
14. Stores a schedule of doctors' appointments or other medically related tasks with notification options.
15. Stores a contact list for current health care providers and insurance companies or other third-party payers.
16. Recommends appropriate health checks to have performed corresponding to a patient's specific profile.
17. Provides alerts to possible health changes shown in the data related to the patient.
18. Provides heart or fitness profiles and recommendations.
19. Provides access to health information on requested topics by using internal or external searches.
20. Enables the creation of a regimen of therapy or recovery activity with schedules and milestones that will notify user if recovery is not in line with guidelines specified by a health provider.
Some advantages provided by this Invention include:
                1. Creating a method for efficiently collecting health care data now when most providers do not maintain their medical records electronically. When all providers have electronic records, a patient may be able to work via direct requests to the providers, but this would not allow automated requests of the health records and the automated filtering of the data requested.        2. Minimizes the effort required from the patient to obtain provider information by working through the standardized, electronic system currently in place to request payment for services rendered.        3. Reduces expense to the patient user by requesting minimum data of interest. Providers are required to provide the data but not free. Providers may charge for costs associated with preparing records, copying, or transmitting.        4. The data from providers is maintained in the same repository with information generated by the user in his daily activities. This may be observations of medically related occurrences or measurements from instruments used at home.        5. Anticipating and reporting possible need for future health care actions based on supplied information.        